Following Post-Pandemic Rise in MRSA Rates, Updated Recommendations Aim to Prevent the Spread of Infection.



By Megan Maloney Roesner

Earlier this year, a group of five medical organizations released updated recommendations for the prevention of methicillin-resistant Staphylococcus aureus (MRSA), transmission and infection. MRSA causes approximately 10% of hospital-associated infections in the United States and these infections are associated with an increased risk of death. Certain infections caused by MRSA rose by as much as 41% during the pandemic after falling in preceding years. In a published article in the Society for Healthcare Epidemiology of America (SHEA), the senior author of the updated guidance and editor of the journal of the Society for Healthcare Epidemiology of America, David Calfee, M.D., said, “The enormous strain put on healthcare during the pandemic may have contributed to the observed increase in some hospital infections. We have data that show MRSA infections rose. The evidence that informs these recommendations shows that we can be successful in preventing transmission and infection. We can get back to the pre-2020 rates and then do even better.” [1]

The updated recommendations aim to assist acute-care hospitals, and elevate antimicrobial stewardship from an “additional practice” to an “essential practice.” When someone who is colonized with MRSA receives treatment with antibiotics for another infection, they may have a higher risk of developing MRSA infection and may be more likely to transmit MRSA to others. Avoiding unnecessary use of antibiotics may decrease these and other risks associated with antibiotic use, such as C. difficile infection. [1]

The guidance describes other practices such as surveillance to detect asymptomatic MRSA carriers and continued diligence among hospital workers for patient contact precautions and proper hygiene practices.

Initially, most cases of MRSA infection occurred in people who were hospitalized or lived in nursing homes. However, in the 1990s, MRSA infections were recognized in people who were not hospitalized or in contact with people in nursing homes. In the 1990s and 2000s, the frequency of cases of MRSA in people who live in the community increased greatly. [2]

We now recognize that infections with MRSA occur in three specific groups of people:

(1) Persons currently in the hospital (hospital-associated MRSA)

(2) Persons with recent hospitalization or ongoing contact with medical clinics, dialysis units, or those undergoing complex outpatient treatments, such as chemotherapy (healthcare-associated MRSA)

(3) Persons in the community (community-associated MRSA). [2]

Anyone can become colonized and then infected with MRSA, although certain people are at a higher risk. Some of the risk factors include:

having a surgical wound and/or intravenous (IV) line; prolonged hospitalization; recent use of antibiotics; immunocompromised status; and being in close proximity to other patients, family members, or healthcare workers who are colonized with MRSA. In hospitals and other long-term healthcare facilities, MRSA can be spread from one patient to another on the hands of healthcare workers. Hands may become contaminated with MRSA when healthcare workers touch a patient's skin, wounds, wound dressings, or devices, such as IV tubing.

Community-associated MRSA (CA-MRSA) risk factors include: Having skin trauma (e.g., "turf burns," cuts, or sores); athletics; shaving or waxing to remove body hair; tattoos or body piercings; physical contact with a person who has a draining cut or sore or is a carrier of MRSA; and sharing personal items or equipment that is not cleaned or laundered between users (such as towels or protective sport pads). CA-MRSA infections may occur more commonly in certain populations, such as daycare centers, prisons, in the military, or in athletes who play on a team. Spread of MRSA within households is common. Some people infected with CA-MRSA have signs of a skin infection. Such skin infections may appear spontaneously and, in some cases, may be mistaken for a spider bite. [2]



It is also possible to develop an infection in areas other than the skin if the bacteria enter the bloodstream through an opening in the skin. Infection can then develop on a heart valve, in a bone, joint, or the lungs, or around devices such as an intravenous line, pacemaker, or replacement joint. Patients with skin infections can be tested for MRSA with a culture. MRSA infections of the lung, bone, joint, or other internal areas usually require blood tests as well as imaging studies (e.g, x-ray, computer tomography scan, echocardiogram).

Reference

Hardy Diagnostics offers a selective and differential culture medium that facilitates the isolation and identification of methicillin-resistant Staphylococcus aureus (MRSA)

Fermented foods like yogurt, kimchi, sauerkraut, and kombucha have long been dietary staples in many parts of the world. Among the earliest evidence for the application of fermentation has been found in pottery vessels discovered in ~7,000 BC China. (1) The accumulation of alcohol and organic acids during the fermentation process inhibits the growth of other microorganisms and activity of enzymes in the food system resulting in foods with an extended shelf-life.(2) Now scientist are discovering that fermented foods may have intriguing effects on our gut.

The latest finding comes from a study that was carried out by researchers at Stanford University. Using a 17 week randomized study, 36 healthy adults were split into two groups. The first group was assigned to increase their consumption of fiber-rich plant foods while the second group was instructed to eat an abundance of fermented foods. Stool samples from each participants was assessed for microbiota composition, function and metabolic output. Blood tests were collected and measured for cytokine levels, response signaling, and immune cell frequency. In this study, high-fiber and high-fermented food consumption influenced the microbiome and human biology in distinct ways. (3,6)

For the fiber group, there was a distinct change in the metabolic pathway of the gut microbiome. The study found that there was a decrease in the branched-chain fatty acids (isobutyric and isovaleric acid), as well as valeric acid. Isobutyric and isovaleric acid have previously been associated with hypercholesterolemia and elevated valeric acid in autism spectrum disorder. However, the fiber group did not have an increase in microbiota diversity. Metagenomic sequencing revealed an increase of different carbohydrate-active enzymes suggesting that fiber may fuel the growth of bacteria through fiber degradation. (3,6)

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Fermented food was proven

to reduce inflammation

and increase the diversity of gut flora.

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For the fermented-food group, there were two distinct changes. The first was a decrease of immune system markers for inflammation. Among the markers was a decrease of interleukin-6, which is a key mediator in several chronic inflammatory conditions such as rheumatoid arthritis and type-2 diabetes. The second distinct change was the overall increase of microbial diversity. Notably, the data suggest that only 5% of the new microbes were directly from consumed microbes and the microbiota diversity shifted to incorporation or increased representation of previously undetected resident strains. (3,6)

Fermented foods offer an opportunity to positively affect the gut microbiome by either (I) providing nutrients to promote or inhibit members of the gut microbiome, or (II) members of the food microbiome establishing residence in the gut and/or interacting with the resident gut microbiome. (4) To ensure the fermented foods you choose do contain living probiotics, look for the words "naturally fermented" on the label, and when you open the jar look for telltale bubbles in the liquid, which signal that live organisms are inside the jar, says Dr. Ludwig, professor of nutrition at Harvard School of Public Health. (5)

References: 1, 2, 3, 4, 5, 6

Covid spike protein may remain in the brain after infection

Long term effects of SARS-CoV-2 infection remain in approximately 15% of patients, even after recovery from the illness, according to senior study author Ali Ertürk, PhD, director of the Institute for Tissue Engineering and Regenerative Medicine at the Helmholtz Center Munich in Germany.(1)

“Brain fog” is an often experienced long term effect. Reported neurological problems also include, brain tissue loss, a decline in thinking ability, and memory loss. Researchers in Germany have found that the spike protein portion of the virus may remain in the brain long after infection with the virus. These spike proteins have been found in the brain tissue of animals and humans upon autopsy. 

These fragments of spike protein may build up and trigger inflammation, causing the neurological symptoms associated with Long COVID.



The researchers propose that the spike protein, which is circulating in the bloodstream, may stay in small openings in the bone marrow of the skull, called niches, and in the meninges, thin layers of cells between the skull and brain. The spike proteins then use channels to enter the brain itself.(1)

While this finding it quite concerning, researchers hope to be able to develop treatments to block the steps in this process in order to help avoid Long COVID brain issues.



Also of great concern is the fact that a recent study discovered spike protein that persisted in the plasma of recently vaccinated young adults who also experienced symptoms of myocarditis. (2)

References: 1, 2

by Julie Tripp,

Technical Support, Hardy Diagnostics